First-Line Treatment Use and Survival Outcomes for Patients With Primary Advanced or Recurrent Endometrial Cancer in Alberta, Canada
To describe first-line treatment patterns and factors impacting survival for patients with primary advanced (stage III-IV) or recurrent (A/R) endometrial cancer (EC) in Canada. This retrospective cohort study used health administrative data for patients with primary A/R EC (2010-2020) in Alberta, Canada. Characteristics by receipt of first-line systemic therapy were compared. Factors impacting overall survival (OS) after first-line chemotherapy were evaluated using a multivariable Cox proportional hazards model. Of 1185 patients included, 817 (68.9%) received first-line systemic therapy (advanced, n = 679 of 885; recurrent, n = 138 of 300). Patients in this cohort were generally younger, with fewer comorbidities than those who did not receive first-line systemic therapy. Patients with recurrent disease who received previous chemotherapy and who had a longer time to recurrence were more likely to receive first-line systemic therapy. The median OS was 53.5 months (95% CI 37.8-80.1); the OS was shorter with older age (≥75 vs. <65 years, adjusted hazard ratio [aHR] 1.62; 95% CI 1.18-2.23) and high-grade versus low-grade histology (aHR 1.99; 95% CI 1.59-3.67). The OS was longer in patients in stage III who had surgery (aHR 0.35; 95% CI 0.24-0.51). Characteristics such as age and comorbidities impacted first-line systemic therapy use in primary A/R EC. Patients who were older, with high-grade histology, stage IV without surgery, and receiving platinum monotherapy had the shortest OS. Effective treatment options are needed to prolong survival for primary A/R EC.